“Public health must continually respond to new threats reflecting wider societal changes. Ecological public health recognizes the links between human health and global sustainability. We argue that these links are typified by the harms caused by dependence on private cars.”

Conventional wisdom maintains that we are slowly recovering from a recalcitrant recession. As we are now entering at least the third year of real economic contraction, continue to reel from the depredations and corruption in a financial sector the federal government treats as sacrosanct, are in the sixth year of a plateau in worldwide oil extraction, and climate change is essentially unmitigated, it should be obvious that American society is arrantly unsustainable – ecologically, fiscally, economically, politically -and ethically.

Few in medicine, nursing and public health share our view; the overwhelming majority of practitioners and their leaders wait –silently, nervously. Many are sincere in this hope for “recovery” because they are –excuse our bluntness- ignorant of how the earth’s ecosystems, resources and the laws of thermodynamics set the parameters of human economic activity.

Succinctly, the world is reaching the physical limits to economic growth. This metaphor, of a finite planet with limited resources and delicately balanced ecosystems, can lead us toward an intellectual paradigm, cultural values, mythology and national identity that support a sustainable world. It follows that it is the narrative from which to generate a new paradigm for the health sciences in the 21st century. It informs us that we are not going back to business as usual and, further, challenges us to envision a future where medicine, nursing, public health and allied fields redefine their place in both the natural world and the political/economy, by which we mean the relationships between economic activity and law, finance, culture, science, and government. Read the rest of this entry »

Barring the unexpected, this fall Congress will leave the present healthcare system largely intact. Ostensibly this will be a triumph for the healthcare industry. But it will be a Pyrrhic victory that pushes an already teetering system further toward breakdown. Regardless of the outcome in the 2009 healthcare debate there are unnoticed ethical issues we must address if we are to have any chance at a viable medical and public health system as we enter an age of economic contraction and restructuring, ecological dilemmas, and natural resource scarcity. Read the rest of this entry »

An interview of Dan Bednarz by Didi Pershouse of The Center for Sustainable Medicine.

“There is no doubt that the amount of resources– not just oil, but other resources too– flowing into health care is going to start shrinking. But here is mainstream health care with this vociferous appetite to grow and grow and do more and more research for arcane and esoteric technological improvements. A lot of that stuff is going to go away…”

Imagine the American healthcare industry as the proverbial proud oak tree that refuses to bend during a windstorm. For decades the industry has been deft at fending off resolution of the Three Cs, cost, coverage and quality of care. Predictably, this political success has nurtured a lack of resilience, by which I mean the ability of an organization to absorb exogenous shocks or disturbances and return to its original state. Read the rest of this entry »

Dr. Jessica Pierce is a writer and bioethicist. She has published a number of books, including Wild Justice: The Moral Lives of Animals, Contemporary Bioethics: A Reader with Cases (forthcoming in October, 2009) Morality Play: Case Studies in Ethics and The Ethics of Environmentally Responsible Health Care. Dr. Pierce is Associate Faculty at the University of Colorado Health Sciences Center, Center for Bioethics and Humanities. She lives in Longmont, Colorado. Her website is http://www.jessicapierce.net.

The first sentence of The Ethics of Environmentally Responsible Health Care reads, “The foundation of human health rests on healthy, stable ecosystems.” One rarely encounters this view expressed in medical literature, yet it lies at the heart of creating a sustainable modern healthcare system.

By far the majority of analyses of the American healthcare focus narrowly on reform –slight to dramatic- through rebalancing the (allegedly) three core issues of the 1) cost, 2) coverage and 3) quality of care. Pierce and Jameton locate medicine in the context of ecological sustainability, which correctly subsumes –not negates- these three issues.

As is often the case when great social change is occurring, few scholars see it coming and also offer a cogent outline of the ethical challenges posed by such momentous upheavals. Pierce and Jameton’s is one of those books.

For example, typically “medical ethics” is devoted to issues stemming from the (allegedly) sacrosanct value of what’s best for the patient. Questions about humanity’s organic connection to and responsibility to the natural environment are not asked or are given short shrift. These authors show how the earth is not a passive, inert and inexhaustible repository of goodies for medicine to dip into at will at no cost or consequence.

This book articulates an alternative discourse integral to the viability of healthcare in the 21st century, as its chapter titles evidence:

1) The Challenge of Environmental Responsibility; 2) Linking Health and Environmental Change; 3) Population and Consumption; 4) Environmental Aspects of Healthcare; 5) The Green Health Center; 6) At the Bedside; 7) Global Bioethics and Justice; and 8) New Ways of Thinking About Bioethics.

“Having heard all of this you may choose to look the other way… But you can never say again you did not know.”

William Wilberforce, British Parliamentarian, 17891

I recently finished reading a critically important book by Professor William R. Catton, Jr., entitled, Overshoot: The Ecological Basis of Revolutionary Change.”2 I not only consider it one of the most influential books I have ever read, but I believe it ranks as one of the most important books ever written, period. I wished I had read it 27 years ago, but at that time I had already left my undergraduate ecological roots behind me while engaged in the excitement and challenges of the start of my public health career at the Wisconsin State Health Department. Well, better late than never!

Despite its maturity, Overshoot remains a vividly fresh and visionary work of brilliance and foresight. The ecological foundations of Catton’s thinking are strong and enduring due to his careful research and interpretive power. His treatise explains much about the human condition that we find ourselves in now, early in the 21st century. In a breathtaking yet concise sweep of history and biology through the eyes of a human ecologist, Catton reveals how we got here and where we are in all probability headed. He summarizes this view as follows: